Department of Anesthesiology, University Hospital Erlangen, Germany; Center for Palliative Medicine, University Hospital of Cologne, Germany.
Eur J Pain. 2010 Apr;14(4):372-9. doi: 10.1016/j.ejpain.2009.06.009. Epub 2009 Aug 6.
Patient-controlled analgesia (PCA) has an established role in managing postoperative pain and has been successfully used in-patients with cancer pain. The variation of opioid requirement over a 24h period for patients with cancer pain is debated with suggestions of reduced need over night.
Retrospective review of 10years (1997-2006) data of all in-patients with cancer pain treated with strong opioids delivered by PCA.
141 patients with cancer pain had a mean cumulative 10day morphine equivalent dose per patient of 671mg (median 470mg; range 10-2170mg). At night (10:01pm to 06:00am) the patient's self administered less bolus doses (69mg, (25%)) than during the other two 8h periods (06:01am to 02:00pm, 91mg (33%) and 02:01pm to 10:00pm, 116mg (42%)). In 8 out of 10days a significant variation in bolus requests was observed with significantly less bolus requests during the night (Friedman test, p<0.05). Furthermore, the median number of delivered bolus requests per patient, at night, was 2-3 compared to the morning and afternoon periods of 3-7 and 3.5-6, respectively.
PCA met individual patient's opioid needs in a safe and effective manner despite a large inter-individual variability in opioid consumption. Moreover, the study indicated a pattern of less opioid requirement at night.
患者自控镇痛（PCA）在术后疼痛管理中具有重要作用，并已成功应用于癌症疼痛患者。癌症疼痛患者在 24 小时内对阿片类药物的需求变化存在争议，有人认为夜间的需求减少。
回顾性分析 1997 年至 2006 年 10 年间（1997-2006）使用 PCA 给予强阿片类药物治疗的所有癌症疼痛住院患者的资料。
141 例癌症疼痛患者的平均 10 天累积吗啡等效剂量为 671mg（中位数 470mg；范围 10-2170mg）。夜间（22:01 至 06:00）患者自我给予的冲击剂量较少（69mg，占 25%），而在其他两个 8 小时时段（06:01 至 14:00 和 14:01 至 22:00）则给予较多冲击剂量（91mg，占 33%；116mg，占 42%）。在 10 天中的 8 天中，观察到冲击剂量请求存在明显变化，夜间的冲击剂量请求明显减少（Friedman 检验，p<0.05）。此外，夜间每位患者的冲击剂量请求中位数为 2-3 次，而上午和下午分别为 3-7 次和 3.5-6 次。
尽管阿片类药物消耗存在个体间的巨大差异，但 PCA 以安全有效的方式满足了个体患者的阿片类药物需求。此外，该研究表明夜间阿片类药物需求较少。
